Type II Amplatzer Vascular Plug in Management of Proximal Splenic Artery Pseudoaneurysm causing Haemosuccus Pancreaticus: A Rare case report

The Amplatzer Vascular Plug device (AVP) Type II has been used for proximal Splenic Artery Embolisation (SAE) in settings of trauma and hypersplenism, but its application in the embolisation of proximal splenic pseudoaneurysms is not widespread, although it is very valid. It is particularly efficient in high-flow arteries, where there is a risk of migration and systemic embolisation compared to other traditional embolic materials. Due to shorter embolisation times, improved precision of deployment and a significantly decreased rate of recanalisation, AVP has been increasingly preferred over pushable coils. Haemosuccus pancreaticus is a rare and potentially lethal cause of upper gastrointestinal haemorrhage via the pancreatic duct. It is usually linked with pre-existing pancreatic inflammation that causes a pseudoaneurysm to rupture into the pancreatic duct, most commonly from the splenic artery. Establishing a diagnosis is difficult with endoscopy or imaging, as the presentation is insidious in nature and bleeding is intermittent at times. Authors report a rare case of a 40-year-old male, a chronic alcoholic, presenting with recurrent melena. Upon imaging, the patient was diagnosed with chronic calcific pancreatitis with a proximal splenic artery pseudoaneurysm, which was managed successfully with AVP Type II. Authors aim to popularise the use of the Amplatzer Vascular Plug Type II in achieving haemostasis of pseudoaneurysms in high-flow arteries.